US4592341A - Method and apparatus for guiding prosthesis - Google Patents

Abstract

A method of and an apparatus for guiding a prosthesis utilizing a flexible sheath in combination with a guide member is taught. Basket forceps assembly which is known in the art is utilized to fracture a calculus located within a coeloma is coupled to the guide member. The guide member carrying the basket is inserted into the coeloma so as to allow it to move past a restriction within the coeloma and without injuring the walls of the coeloma. The guide member, once moved past the restriction, is used as a guide to dispose a prosthesis passed over the guide member at a given location in a smooth manner.

Description

BACKGROUND OF THE INVENTION

The invention relates to a method of and an apparatus for guiding a prosthesis, and more particularly, to such method and apparatus which utilizes an endoscope to insert a prosthesis or a tube into coeloma and to retain it at a given location therein.

When an opening of a bile duct into the duodenum undergoes a restriction, biliary secretion or pancreatic fluid may be prevented from flowing into the duodenum. This not only affects the digestion, but may cause jaundice, and hence, it has been the practice in the prior art to remove the restriction by a surgical operation. However, patients of an advanced age or who suffer from heart disease may not endure such operation. Recently, for those patients who are not amenable to such operation or where the restriction is caused by a temporary tumor which may be cured over a prolonged period of remedy, a remedy is attempted which utilizes an endoscope to place a cylindrical tube or prosthesis, formed of a synthetic resin material, into the affected part where the restriction has occurred, thus allowing the biliary secretion or pancreatic fluid to pass therethrough.

Such remedy will be briefly described with reference to FIGS. 1A to 1C. In FIG. 1A, there is shown an endoscope 1 including a forceps channel through which aguide wire 2 extends. The distal end 3 of the endoscope 1 is then inserted into coeloma. When theextremity 3a of the distal end 3 has reached anopening 4 of the duodenum, theguide wire 2 is push driven inward. The front end 2a of theguide wire 2 which projects forwardly from the extremety of the distal end is then forced into arestriction 5 to force it open until it completely extends through the restriction. Aprosthesis 6 or a tube to be retained in place within the coeloma is then passed over the proximate end portion of theguide wire 2, followed by apusher tube 7 which is utilized to drive the prosthesis inward. When thepusher tube 7 is driven inward, theprosthesis 6 moves along theguide wire 2 through the forceps channel of the endoscope 1 and reaches the location of theopening 4. As thepusher tube 7 is further driven inward, theprosthesis 6 is forced into therestriction 5 to force the walls of therestriction 5 apart, as shown in FIG. 1B. The inward drive applied to thepusher tube 7 ceases when the prosthesis has been inserted to a suitable position. Theguide wire 2 is then withdrawn from the endoscope 1, and then the distal end 3 of the endoscope 1 is removed from the coeloma, thus leaving only theprosthesis 6 within therestriction 5. In this manner, biliary secretion or pancreatic fluid is allowed to flow through the prosthesis into the duodenum. In this manner, the risk involved with a surgical operation is avoided, and the pains caused to a patient are suppressed to a relatively low level.

However, the described remedy has a drawback in that theguide wire 2 must have a degree of rigidity which is required to allow it to be passed through therestriction 5. However, the rigidity or toughness may cause the front end 2a of theguide wire 2 to abut against the wall 8 of coeloma before it is passed through therestriction 5, as shown in FIG. 1C. Such abutment may cause the wall 8 to be injured by the front end 2a of the guide wire, and in worst cases, a risk arises that a hole may be pierced in the wall 8.

SUMMARY OF THE INVENTION

In view of the foregoing, it is an object of the invention to provide a method of and an apparatus for guiding a prosthesis which permits a prosthesis to be placed within a restriction of coeloma to ensure a free flow of body fluid, by facilitating the insertion of a guide member into a restriction without injuring the wall of the coeloma adjacent to an affected area.

According to the invention, a guide member may be readily passed through a restriction without injuring the wall of the coeloma, thus enabling a prosthesis to be placed in the restriction.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A to 1C are schematic illustrations of a conventional arrangement for guiding a prosthesis during its use; FIG. 1B being an enlarged view to illustrate the prosthesis which is passed through a restriction and FIG. 1C being an enlarged view which shows the front end of a guide wire abutting against the wall of the coeloma;

FIGS. 2A to 2C are an elevational section of an apparatus for guiding a prosthesis according to one embodiment of the invention, and fragmentary, enlarged cross sections thereof;

FIGS. 3 to 7 are schematic illustrations of the apparatus shown in FIGS. 2A to 2C as it is operated within the coeloma;

FIG. 8 is an elevational section of an apparatus for guiding a prosthesis according to a second embodiment of the invention;

FIGS. 9, 10 and 11 are schematic illustrations of the apparatus shown in FIG. 8 as it is operated within the coeloma; and

FIG. 12 is an elevational section of a modification of the apparatus shown in FIG. 8.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring to FIGS. 2A to 2C, there is shown an apparatus according to one embodiment of the invention. FIG. 2A is an elevational section, showing the general arrangement of the apparatus 11 for guiding a prosthesis. The apparatus 11 comprises aflexible sheath 12 which is adapted to be received in a forceps channel of an endoscope, not shown, aguide member 27 which is freely disposed within theflexible sheath 12, anoperating unit 24 connected to the rear end of theguide member 27, and abasket assembly 10 connected to the distal end of theguide member 27.

Theflexible sheath 12 comprises aflexible tube 13 which is adapted to be received in a forceps channel, not shown, and afitting 21 connected to the rear end of thetube 13 and formed with afluid inlet 19. Thus, a treatment fluid may be injected into thetube 13.

Theguide member 27 comprises thebasket assembly 10 which is formed by a plurality of resilient wires of reduced diameter which may be expanded into or shrunk from a cage configuration, anintermediate length 27b defined by a bundle of resilient wires, a detent 18 connected to anoperating pipe 23 to be described later, and aresilient wire 27a extending to the proximate end which comprises one of the resilient wires mentioned above.

Thebasket assembly 10 is formed by a plurality ofresilient wires 16 of reduced diameter, for example. The opposite ends of the wires are clamped together by afront end tip 15 and arear end tip 17, respectively. A plurality of bends 16a are formed in each of theresilient wires 16 so as to define a cage-shaped wire basket when these wires are expanded. Thefront end tip 15 has a rounded extremety, which is effective to prevent the wall of the coeloma from being injured by such extremety when theguide member 27 is inserted into the coeloma. After being clamped together by therear end tip 17, theresilient wires 16 extend in a bundle of an increased length to define theintermedite length 27b, the rear end of which is secured to ananchorage 18b of thecylindrical detent 18, as shown in FIG. 2B. A recess 18a is formed in the rear end of the detent 18, and only one of the resilient wires from the bundle extends rearwardly, substantially in alignment with the center axis of the recess 18a to form the proximate endresilient wire 27a.

Theguide member 27 thus constructed is passed through theflexible sheath 12 and can be driven back and forth. Then thebasket assembly 10 moves out of or into the distal end of thesheath 12, and during such movement, the entire basket assembly can be resiliently expanded or shrunk in a direction perpendicular to the axis of theguide member 27.

The construction of theoperating unit 24 will now be described with reference to FIG. 2C. Theoperating unit 24 generally has a cylindrical, stepped configuration. Its front portion internally houses aguide block 31 in which awire passage 29 is formed. Anoperating pipe 23 having an increased length is secured in the front end of theguide block 31, and extends forwardly through an opening 24c formed in the front wall of theunit 24. The combination of theoperating pipe 23, thewire passage 29, a bore 24a formed in the rear portion of theoperating unit 24, and an opening 24b at the rear end of theoperating unit 24 defines a passageway which is continuous throughout these members. Female threads are formed in the top of theguide block 31, extending toward thewire passage 29. Threadably engaged with the female threads is a clampingscrew 28 having aknob 25 at its head and which extends through an opening formed in the top of the operatingunit 24. When thescrew 28 is to be used to clamp thewire 27a of theguide member 27 within the operatingunit 24, the operatingpipe 23 is initially positioned by inserting its front end until it is fitted in and abuts against the recess 18a in the detent 18 (see FIG. 2B). Thescrew 28 may be then turned to hold theresilient wire 27a against the internal wall of thewire passage 29, thus securing it. In this manner, by tightening or loosening thescrew 28, the operatingunit 24 can be detachably mounted on theresilient wire 27a. The rear portion of the operatingunit 24 is formed as agrip 26, which may be held by hand to move the entire operating unit along theguide member 27, thus opening or closing or expanding and shrinking the basket assembly 10 (see FIG. 2A).

It will be noted in FIG. 2A that an O-ring 22 is fitted between the fitting 21 and the operatingpipe 23 in the region of an opening of the fitting 21, thereby providing a seal therebetween.

The operation of the apparatus will now be described with reference to FIGS. 3 to 7. When the apparatus 11 shown in FIG. 2A is used to place aprosthesis 33 in arestriction 5 of abile duct 35, the rear end of theguide member 27 or theresilient wire 27a is inserted into the front end of theflexible sheath 12, and is passed therethrough until thebasket assembly 10 is received within theflexible sheath 12. The rear end of theresilient wire 27a which projects out of the fitting 21 on theflexible sheath 12 is then inserted initially into the operatingpipe 23 of the operatingunit 24 while, thescrew 28 is fully loosened. When the front end of the operatingpipe 23 is fitted into the recess 18a formed in thedetent 18, as shown in FIG. 2B, thescrew 28 is tightened, thereby securing theresilient wire 27a within thewire passage 29. This provides an integral connection between theguide member 27 and the operatingunit 24.

The apparatus is then inserted into the forceps channel of an endoscope, the distal end of which is inserted into the coeloma until the front end of theflexible sheath 12 extends into thebile duct 35 through the teat of the duodenum. After guiding the front end of theflexible sheath 12 to the proximity of therestriction 5, the operatingunit 24 which is located externally of the forceps channel of the endoscope is manually held at its rear end, and is driven inward to cause an expansion of thebasket assembly 10, as shown in FIG. 3, thus forcing the surrounding walls of therestriction 5 apart. The basket assembly is then closed or shrunk again. By repeating the expansion and the shrinkage of the basket assembly, therestriction 5 may be forced open to allow theguide member 27 to move past the restriction as shown in FIG. 4.

When thebasket assembly 10 has moved past therestriction 5, thescrew 28 is loosened while maintaining thebasket assembly 10 open and then the operatingunit 24 is withdrawn from theguide member 27. Theflexible sheath 12 is then withdrawn from the forceps channel of the endoscope. However, since theguide member 27 has a length which is preferable equal to or greater than twice the length of theflexible sheath 12, it is possible to maintain theguide member 27 in the condition mentioned above while withdrawing theflexible sheath 12. While theguide member 27 is left in the coeloma as shown in FIG. 4, aprosthesis 33 and apusher tube 34 are sequentially passed over theguide member 27 as shown in FIG. 5. By driving thepusher tube 34 inwardly, theprosthesis 33 may be inserted into therestriction 5, whereupon it may be placed within therestriction 5 as indicated in FIG. 6.

When theprosthesis 33 is retained in place, thebasket assembly 10 is shrunk and is withdrawn from the coeloma together with theguide member 27, as is the endoscope. The ultimate result is theprosthesis 33 is left extending through therestriction 5 as indicated in FIG. 7. Under this condition, theprosthesis 33 is effective to displace biliary excretion which may accumulate within thebile duct 35.

It will be understood that with this embodiment, the roundedfront end tip 15 is formed on the extremety of thebasket assembly 10, and is passed through therestriction 5 while repeating its expansion and shrinkage, thus avoiding any undue stresses applied to the walls of the restriction. This prevents the likelihood that the walls of the coeloma may be injured.

It will also be noted that the operatingunit 24 which causes an expansion and shrinkage of thebasket assembly 10 is detachably mounted. This allows theflexible sheath 12 to be withdrawn from theguide member 27, thus permitting the basket forceps assembly to be utilized with the apparatus 11.

Since theguide member 27 or thewire 27a has a length which is equal to or greater than twice the length of theflexible sheath 12, theguide wire 27a may be held externally while withdrawing theflexible sheath 12 from theguide member 27, thus preventing thebasket assembly 10 from being disengaged from therestriction 5.

In the description mentioned above, an expanding and shrinking construction is formed by the basket, by way of example, but it should be understood that any other alternate construction may be provided for the expanding and shrinking unit.

FIGS. 8 to 11 show a second embodiment of the invention in which similar parts to those mentioned above in connection with the first embodiment are designated by corresponding reference characters, and hence will not be described again.

In the embodiment shown in FIG. 8, anapparatus 50 for guiding a prosthesis comprises aguide member 27, aflexible sheath 40, an operatingunit 41 which causes a movement of the guide member back and forth, arelay sheath 42, aprosthesis 43 and apusher tube 66.

The guide member comprises aguide wire 27A and abasket assembly 10, which are constructed in quite the same manner as those shown in connection with the first embodiment, and awire length 27c extending rearwardly from therear end tip 17 which defines thebasket assembly 10.

Theflexible sheath 40 comprises aflexible tube 44 of an outer diameter which permits it to be received in the forceps channel of an endoscope 1 (see FIG. 9). A fitting 45 which is formed with male threads 45a is connected to the rear end of thetube 44. Theguide wire 27A freely extends through thetube 44, and the operatingunit 41 or therelay sheath 42 can be selectively connected to the rear end of thetube 44.

The operatingunit 41, comprises anoperating handle mechanism 46 of a sliding type, and aconnector 47 which connects themechanism 46 to theflexible tube 44. Theconnector 47 comprises a socket 47a, the front end portion of which is internally formed withfemale threads 47b for threadable engagement with the male threads 45a formed around the fitting 45, and the rear portion of which is integrally provided with a cylindricalengaging element 47d, the outer periphery of which is formed with an engaginggroove 47c. Themechanism 46 includes ahandle body 49 with a slidingrail 48 formed therein, and a tube fitting 51 which is attached to the front end of thebody 49. Aslider 52 is slidably engaged with therail 48. More specifically, the tube fitting 51 includes acylindrical support 53 having a bore in which a piston 54 having a through-opening 54a is disposed so as to be movable in a direction perpendicular to thebody 49. The piston 54 is connected to anoperator 55, while thebody 49 also houses acoiled spring 56 which urges the piston 54 toward theoperator 55. Accordingly, when theconnector 47 is connected to the fitting 45 on theflexible tube 44 and then theengaging element 47d of theconnector 47 is engaged with the through-opening 54a formed in the piston 54 which is then urged by the coiledspring 56, a connection is established between theflexible tube 44 and thebody 49. Theslider 52 includes abody 57 which is fitted with therail 49. Ashank 61 which can be axially translated by turning an operatingknob 59 is disposed in thebody 57, which also houses areceiver 62 which is adapted to engage the free end of theshank 61. In this manner, the rear end of theguide wire 27A which projects through the rear end of theflexible tube 44 may be clamped between theshank 61 and thereceiver 62. Accordingly, theoperating handle mechanism 46 which is detachably mounted on the rear end of theguide member 27 extending through the rear end of theflexible tube 44, may be used to move theguide wire 27A back and forth, thus causing thebasket assembly 10 to project through the distal end of theflexible tube 44 so as to expand it in a direction perpendicular to the axis of theguide wire 27A or to cause it to shrink and be retracted into thetube 44.

Therelay sheath 42 comprises anextension tube 63 of substantially the same diameter and the same length as theflexible tube 44. A tube fitting 64 is disposed on the free end of theextension tube 63 and is internally formed withfemale threads 64a which are adapted to threadably engage the fitting 45 on theflexible tube 44, thus allowing theextension tube 63 to be detachably connected in seriatim to theflexible tube 44.

Theprosthesis 43 has a plurality offlaps 65 or barbs formed around its outer periphery to prevent its unintended withdrawal. Theprosthesis 43 has an inner diameter which is greater than the outer diameters of theflexible tube 44 and theextension tube 63, and has an outer diameter which is less than the internal diameter of the forceps channel of the endoscope 1, thus allowing it to be passed over theflexible tube 44 and therelay sheath 42, serving as a guide and which are then connected together. In FIG. 8, thepusher tube 66 is shown as having internal and external diameters which remain the same as theprosthesis 43.

When theapparatus 50 is used to place theprosthesis 43 within therestriction 5 of thebile duct 35 of a living body, the operation begins with assembling the guiding apparatus in a condition which facilitates the insertion of the wire. Specifically, theconnector 47 is connected to the fitting 45 on theflexible sheath 40. Theguide wire 27A is then inserted into theflexible sheath 40 through the front end thereof until thebasket assembly 10 is completely received therein. Theconnector 47 which is thus connected to theflexible sheath 40 has its engaging element 47a engaged with the tube fitting 51 on the operatingunit 41 so as to be secured thereto. Thereafter, the rear end of theguide wire 27A which extends through the rear end of theflexible sheath 40 is secured to theslider 52 by turning theknob 59.

When the described assembly is completed, theflexible sheath 40 together with theguide wire 27A and thebasket assembly 10 is inserted into the forceps channel of the endoscope 1. Subsequently, thedistal end 3a of the endoscope 1 is inserted into the coeloma until the front end of theflexible sheath 40 is inserted into thebile duct 35 through the teat of the duodenum. Subsequently, by moving the operatingunit 41 back and forth to open or close (to expand or shrink) thebasket assembly 10, the front end of theguide wire 27A is driven into therestriction 5, as illustrated in FIG. 9. By utilizing the repeated opening or closing of thebasket assembly 10 during the insertion process, both theguide wire 27A and theflexible sheath 40 may be brought to a position shown in FIG. 10 extending through therestriction 5 while avoiding the abutment of the front end of theguide wire 27A against the walls of coeloma which may injure them or avoiding the formation of any pierced opening. Thereafter theprosthesis 43 is placed within therestriction 5. In the first embodiment mentioned above, this placement required the withdrawal of theflexible tube 12, which may be a cumbersome operation.

Alternately, an improvement in this respect is achieved with the present embodiment. Specifically, when the insertion of theguide wire 27A into therestriction 5 is completed, theknob 59 is turned to unlock theguide wire 27A, thus allowing theconnector 47 to be disengaged from theflexible sheath 40. In this manner, theentire operating unit 41 is disconnected from theflexible sheath 40 and theguide wire 27A. Therelay sheath 42 is then connected to the fitting 45 on theflexible sheath 40, and theprosthesis 43 and thepusher tube 66 are sequentially passed over the rear end of therelay sheath 42. By utilizing therelay sheath 42 and theflexible sheath 40 which are coupled together by thepusher tube 66 as a guide, theprosthesis 43 may be driven inward toward therestriction 5, thus allowing it to extend through therestriction 5 as shown in FIG. 11. After this, theguide wire 27A and theflexible sheath 40 and therelay sheath 42 which are coupled together are withdrawn from the endoscope 1, which is also withdrawn from the coeloma, thus leaving theprosthesis 43 in place within therestriction 5. It will be appreciated that theprosthesis 43 can be placed within therestriction 5 without requiring a withdrawal of theflexible sheath 40 which has been required in the first embodiment in the process of placing the prosthesis.

It will be understood that the likelihood that the walls of the coeloma may be injured is avoided in the present embodiment as in the first embodiment. Since it is unnecessary to withdraw theflexible sheath 40, there is no possibility that theguide wire 27A may be inadvertently disengaged from therestriction 5. The construction including theflexible sheath 40 and therelay sheath 42 which are coupled together for use as a guide to introduce the prosthesis into therestriction 5 allows a reduction in the overall length of theguide wire 27 and theflexible sheath 40. Specifically, the length may be similar to that of a treatment instrument used in an endoscope such as basket forceps, and a reduction in the resistance which is presented to the movement of the wire facilitates a movement of theguide wire 27A within theflexible sheath 40, thus allowing a reliable operation.

FIG. 12 shows a modification to the present invention. Specifically, a plug connection is utilized in connecting aconnector 47A with aflexible sheath 40A or connecting arelay sheath 42A to theflexible sheath 40A. Specifically, the rear end of theflexible sheath 40A is left plain cut as it is molded while each of theconnector 47A and a tube fitting 71 on therelay sheath 42A is provided with atubular insert 72A or 72B having an outer diameter which is slightly greater than the internal diameter of theflexible sheath 40A so that a clearance fit is formed therebetween, thus allowing the connection or the disconnection to be achieved by a mere push-in or withdrawal of theinserts 72A and 72B into or from theflexible sheath 40A.

It should be understood that the invention is not limited to the embodiments described above. Specifically, the guide wire, the flexible sheath, the relay sheath and the pusher tube may be coiled in configuration. The operating unit may be provided with a water supply faucet which is disposed on the tube fitting. Alternatively, rather than providing a structure which may be operated by single hand, the handle body may be provided with a detachable knob to permit the arrangement to be operated with both hands. In addition, the prosthesis may be of a variety of currently available configuration including a pigtail having a loop or loops on either end or both ends.

Claims (11)

What is claimed is:

1. A method of placing a prosthesis within a restricted passageway comprising the steps of:

a first step of inserting the front end of a flexible sheath, containing a guide member such as a guide wire extending therethrough, to the proximity of a restriction within the restricted passageway;

a second step of operating an operating unit which causes a movement of the guide member back and forth so as to open or close and thereby expand or shrink a resilient basket attached to the front end of the guide member and thereafter moving the basket past the restriction;

a third step of leaving the guide member which has moved past the restriction in place within the passageway while withdrawing the flexible sheath out of the passageway;

a fourth step of passing a prosthesis over the guide member, followed by passing a pusher tube over the guide member with, the pusher tube driving the prosthesis inward along the guide member;

a fifth step of driving the pusher tube inward to place the prosthesis within the restriction; and

a sixth step of withdrawing the guide member out of the passageway.

2. A method of placing a prosthesis within a restricted passageway comprising the steps of:

a first step of inserting the front end of a flexible sheath, containing a guide member such as a guide wire extending therethrough, to the proximity of a restriction within the passageway;

a second step of operating an operating unit which causes a movement of the guide member back and forth so as to open or close and thereby expand or shrink a resilient basket attached to the front end of the guide member and thereafter moving the basket past the restriction;

a third step of leaving the flexible sheath within the passageway while disconnecting the operating unit from the flexible sheath;

a fourth step of connecting a relay sheath to the flexible sheath which is left within the passageway;

a fifth step of passing a prosthesis over the relay sheath, followed by passing a pusher tube over the relay sheath, so as to drive the prosthesis inward along the sheath;

a sixth step of driving the pusher tube inward so as to place the prosthesis within the restriction; and

a seventh step of withdrawing the flexible tube and the relay sheath through which the guide member extends from within the passageway.

3. A kit for placing a prosthesis within a restricted passageway, comprising:

a flexible sheath which can be received in a forceps channel of an endoscope;

a guide member freely extending through said flexible sheath;

an operating unit detachably connected to the rear end of said guide member for causing a movement of said guide member back and forth;

basket assembly means connected to the front end of said guide member and movable back and forth in response to an operating of said operating unit, said basket assembly means moving out of or into the front end of said flexible sheath in accordance with the movement of said guide member so as to expand or shrink said guide member as a whole in a direction perpendicular to the axis of said guide member;

a prosthesis to be placed at a given location using said guide member as a guide; and

a pusher tube for driving said prosthesis along said guide member.

4. A kit according to claim 3 in which said flexible sheath has an external diameter which is less than the internal diameter of said prosthesis.

5. A kit according to claim 3 or 4 in which the rear end of said flexible sheath is adapted to be connected to a relay sheath having substantially the same diameter as said flexible sheath.

6. A kit according to claim 3, in which a portion of said guide member is inserted into said passageway through said endoscope and which is exposed externally of said endoscope has a length which is greater than the length of said flexible sheath.

7. A kit according to claim 3, in which said operating unit is detachably mounted on the rear portion of said guide member and is formed with a through-opening through which said guide member extends and in which said guide member is a resilient wire.

8. A kit according to claim 7, in which an operating pipe of a given length extends from said operating unit and communicates with the through-opening formed in said operating unit, thereby providing a passageway through which said guide member extends, and in which said guide member is a resilient wire.

9. A kit according to claim 3, in which said operating unit is mounted on the rear end portion of a resilient wire which functions as said guide member and extends through the rear end of said flexible sheath.

10. A kit according to claim 9, in which a connector is mounted on the front end of said operating unit and is constructed so as to permit its connection with said rear end of said flexible sheath.

11. A device for moving past a restricted passageway, comprising:

a flexible sheath which can be received in a forceps channel of an endoscope;

a guide member freely extending through the flexible sheath;

an operating unit detachably connected to the rear end of the guide member for causing a movement of the guide member back and forth; and

basket assembly means connected to the front end of the guide member and movable back and forth in response to operation of the operating unit, said assembly means moving out of or into the front end of the sheath in accordance with the movement of the guide member so as to expand or shrink as a whole in a direction perpendicular to the axis of the guide member and thereby urge said basket assembly means past said restriction in said restricted passageway.

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